Between 1984 and 2012 coal exports from Newcastle increased ten-fold from 21 million tonnes per annum (Mtpa) to 210 Mtpa. The proposed fourth terminal (T4) would see this increase to 330 Mtpa, making Newcastle the world’s largest coal port.

A survey of 580 households found that fewer than 10% of residents support T4 and most are concerned about health impacts. Newcastle residents routinely wipe coal dust from every horizontal surface inside and outside their homes. T4 could also mean 100 more uncovered coal trains every day, resulting in even higher levels of particle pollution. There are currently 25,000 children attending schools within 500 metres of the coal corridor.

The health and social harms of coal mining and transport are well documented. People living in coal-effected communities are more likely to suffer heart, lung and kidney cancer, respiratory and cardiovascular disease and birth defects. There is a direct link between long-term exposure to particle pollution and hospital admissions, emergency department attendance, asthma, respiratory and cardiovascular disease, congestive heart failure and premature death.

The fine particles associated with coal mining, coal transport and the diesel emissions from coal trains are monitored at locations throughout the Hunter Valley. During the last year, monitoring stations recorded 98 exceedances of the national standard for PM10 (particles of up to ten microns in diameter). Residents who subscribe to the EPA’s air pollution alerts often receive more than one each day, especially on dry, windy days when coal dust is blown from the valley’s vast open cut mines.

NSW Planning Minister Brad Hazzard has established Planning Assessment Commission to weigh up T4’s merits and impacts. They must weight up the concerns raised in 500 submissions, 90% of which opposed the terminal. Commissioners will advise the Minister in early 2013. In their submission on T4, NSW Health noted that there are already exceedances of the national PM10 standard in Newcastle and that uncovered coal wagons and diesel emissions will increase particle pollution in residential areas between the mines and the port.

There are also concerns about workers’ health. A cancer cluster has been identified at one of Newcastle’s three existing coal terminals. Between 1983 and 2006, 63 cancers including melanoma, prostate and bowel cancer were diagnosed among 859 company employees. Terminal workers are 1.8 times more likely to be diagnosed with cancer than the average population and 2.8 times more likely than those only employed at a neighbouring terminal.

The proposed terminal would also have a huge environmental impact. Increased coal exports would mean at least 15 new or expanded open-cut coalmines in the Hunter Valley and Gunnedah Basin, resulting in destruction of forests and agricultural land, and polluted water. Burning the coal would produce more than 300 million tonnes of greenhouse pollution each year, more than every power station and every vehicle in Australia. The proposed terminal and its uncovered coal piles would displace hundreds of hectares of wetland on Kooragang Island where 117 bird species have been recorded, including at least four migratory shorebirds. Much of Kooragang Island is internationally recognised under the Ramsar Convention.

The community are concerned however that these facts alone will not prevent the NSW Government approving Port Waratah Coal Services proposal, and that T4 will only be rejected through community and political pressure. The local alliance of 14 community groups is actively communicating these concerns to elected representatives but seek wider community support.

Health professionals and groups can help protect the Newscastle community from the run-away impacts of the coal boom by:

2. Donate to the Coal Terminal Action Group http://tinyurl.com/stopt4donate who are currently raising funds for air quality monitoring along the coal corridor and to place a full page ad in the Newcastle Herald.

The international health and medical community have developed a joint statement on climate health and wellbeing calling for health to be central to climate action during the COP18 international climate change negotiations in Doha, Qatar.

Signatories to the Doha Declaration for Climate, Health and Wellbeing include the World Medical Association, the International Council of Nurses, International Federation of Medical Students, Health Care Without Harm, European Public Health Association, Royal College of General Practitioners (UK), Climate and Health Council, OraTaiao: The New Zealand Climate & Health Council, NHS Sustainable Development Unit, Umeå Center for Global Health Research, Climate and Health Alliance, Public Health Association of Australia, the Australian Healthcare and Hospitals Association, Doctors Reform Society, Australian Association of Social Workers, and the Australian Medical Students Association and many others.

The Doha Declaration calls for health to be central to climate action, and highlights the opportunities to improve health through emissions reductions – pointing out that reducing fossil fuel consumption and moving to low carbon energy systems can deliver many benefits to health worldwide.

“The impact of climate change on health is one of the most significant measures of harm associated with our warming planet,” the Declaration says. “Protecting health is therefore one of the most important motivations for climate action.”

This effort builds on the collaboration at the 2011 global climate and health summit among the health and medical community in advocate for climate action.

The Doha Declaration outlines why health experts are extremely worried about the slow progress at the international climate negotiations, and highlights how the health co-benefits of emissions can build support for ambitious climate action.

Getting policy traction: The 2012 Climate and Health Alliance report Our Uncashed Dividend produced in partnership with The Climate Institute has hit a chord with media, community, and policymakers.

It was released in 2012 to widespread media coverage, has been the subject of many invited presentations, and has stimulated and informed the first ever submission from the Australian Government on health to the United Nations Framework Convention on Climate Change process occurring in October 2012, written following a meeting with CAHA in August 2012.

(The SBSTA is one of two permanent subsidiary bodies to the Convention established by the COP/CMP. It supports the work of the COP and the CMP through the provision of timely information and advice on scientific and technological matters as they relate to the Convention or its Kyoto Protocol. The Nairobi Work Program is set up to to assist all Parties to improve their understanding and assessment of impacts, vulnerability and adaptation to climate change; and make informed decisions on actions and measures to respond to climate change on a sound scientific, technical and socio-economic basis).

The Australian Government submission proposes that further work be undertaken to “understand the physical and psychological impacts of climate change on individual and community health” and suggesting that this work could “draw on the experience of health sector workers, as a useful resource in understanding and addressing the climate change impacts on health”.

How to translate research evidence into policy? What research methodologies offer the best results for social policy outcomes? How can researchers, policymakers and the third sector work together to deliver better results for people and communities? How do we create policy networks that can be adaptive, resilient and flexible enough to respond to the significant societal challenges we face?

The Power to Persuade forum hosted by University of Melbourne and Good Shepherd on Wednesday 5th September 2012 brought together researchers, service providers, policymakers and policy advocates to discuss some of these questions to build a better collective understanding of the necessary elements of effective social policy outcomes.

Transforming governance

Keynote speaker Mark Considine acknowledged the need for transformational change in public policy development, and proposed the establishment of civil society governance networks, built on “deep partnerships” between institutions and other actors, and guided by judicial bureaucratic mandates, may provide a model for the kind of societal leadership that can fill the gaps currently created by the ‘short termism’ endemic in current political governance.

Considine pointed to complex policy challenges such as climate change, food insecurity and people movement, suggesting that the capacity for transformational change needed to address these issues may not reside in existing institutions, and if we are to avoid disruption and upheaval triggered by environmental shock, new governance networks are needed.

Building the sorts of partnerships required for adaptive resilient policy responses can begin through, for example, data sharing, pooled budgets and shared research, to build trust and common goals – and these smaller steps can lead to deeper ties over time that can better manage and respond to transformational change.

Economics and policy decision-making

Economist Alan Sheill spoke about the harsh realities of having to determine priorities in health and how economics can provide important insights about cost: benefit ratios to inform decision-making.

While for health and welfare professionals, service providers and policymakers this is a challenging dimension of social policy, Shiell says: “we do not have enough resources (time, finances, space etc) to do everything we would wish to do to promote health and social well-being – therefore we need to choose”.

However, economic evidence is not always necessary, not does it always inform policy decision-making, Friell said, pointing out that very often, the public and politicians are not aware of the economic cost of political decisions.

It was important for social policy advocates to use the rhetoric of economic costs to build support for actions, but recognize that economic analysis does not always reflect broader social benefits and there is a need to develop research methods that can incorporate less easily quantifiable health and social wellbeing gains from social policy initiatives.

Methodologies and case studies

Other speakers outlined case studies and research methodologies that offer powerful and effective examples of social policy innovation, such as J2SI, a long term program for homelessness. Damon Alexander shared some insights into the benefits of Social Network Analysis, a research method that is being used in multiple ways eg to map strategic information networks to evaluate innovation in government, look at information flows of strategic advice within primary care partnerships, and understand formal and informal relationships within organisations.

Social network analysis was a powerful tool for understanding relationships between actors in a particular policy environment, and mapping “what” happens and “when” but not so much about “how” or “why”…

Other case studies included great examples of participatory rights based methodologies from Karen Dowling from the Victorian Department of Education on ‘Listen 2 Learners’; and Leo Fieldgrass from the Brotherhood of St Lawrence on ‘Mobile Matters’.

Final word

John Falzon from St Vincent de Paul responded to this session, and spoke about the exceptionally important job of engaging with community and with people in developing social policy, finished with a poetic warning from Martin Luther King in saying: “A riot is at best the language of the unheard.”

Like all good modern events, the Twitter stream provided insight into people’s thinking. You can search for some of the twitter stream on the forum by using the hash tag: #powertopersuade – a small sample is reproduced here:

The meeting was hosted by Western Health CEO Kathryn Cook at the new Sunshine Hospital and made possible by Friends of CAHA and Doctors for the Environment member Dr Forbes McGain and his colleague at Western Health, sustainability officer Catherine O’Shea.

Commissioners Tim Flannery, Lesley Hughes, Roger Beale and Gerry Hueston and Commission media advisor Amanda McKenzie attended the meeting with around 25 people including health professionals from medicine, nursing, allied health, psychology and public health disciplines, as well as health care services and policy people.

Some of the topics of discussion included: What does health sector know about climate change? What can be done to build a greater awareness among health professionals about the risks to health from climate change? What are the opportunities for the health sector to demonstrate leadership in responding to, and being seen to respond to, climate change?

A lack of awareness among health professionals about the implications of climate change for health was raised as a barrier to the sector effectively responding. The education of all health professionals on climate and health was considered vital and urgent – including from undergraduate level to continuing professional development for the existing workforce.

Professor Lesley Hughes presented the findings from the Commission’s report on climate change and health and its latest report on climate impacts and opportunities for Victoria. Professor Tim Flannery explained why they were keen to engage with health professionals: to raise awareness about the implications for health from climate change but also to encourage health professionals to use their own status as respected members of the community to help build community understanding about the need to respond urgently to climate change.

Professor Flannery’s comments to media before the meeting summed this up: “Climate change is one of the serious threats to Victoria’s health, especially those in our community who are most vulnerable, like the elderly and the very young. Few Australians are aware of the risks to their health and the health of their family and community. While much of the public discussions on climate change have emphasised the environmental impacts, a greater focus needs to be on the health consequences. Climate change must be considered a public health priority.”

the quarantining of public health sector budgets separating capital from operational expenditure made it difficult to make the case for the implementation of energy efficiency measures as the impact of costs were felt in one budgetary area and the savings realized in another.

Other socio-cultural challenges include the complex psychological responses to climate change and the difficulties in finding effective ways to communicate such a complex science in ways that are not disempowering and alarming. Serious concerns were raised about the neglect of mental health risks and the lack of preparedness to respond to severe risks to mental health.

The need to engage young people in particular was noted and the importance of including their voices and their concerns in relation to how we respond to climate change.

A lack of climate ‘literacy’ among health professionals was considered a barrier to health professionals understanding the implications of, and the need to respond to, climate change. Education about climate change and health is needed in undergraduate and postgraduate curricula for all health professionals, as well as in continuing professional development for current practitioners, the meeting heard.

There is also a need for the health sector to gain an understanding of the gendered nature of the health implications of climate change and climate policy, especially in relation to the differential effect of climate change on women.

Other concerns were raised about the mistruths being promoted in the community by the Victorian Health Minister David Davis in a recent brochure claiming the carbon tax would hurt health by driving up energy costs.

While there is some degree of preparedness that will help the health sector respond to climate change, with emergency power supplies, and heatwaves plans, overall the health sector is not well prepared to respond to climate impacts. Responses to other risks to health from increased ozone, affecting respiratory health; food and water borne disease and threats to infrastructure from extreme weather event were not well developed and pose potentially serious risks.

Climate Commission media advisor Amanda McKenzie advised health professionals to see the issue as an opportunity for the health sector to make a strong case for action to cut emissions that will also benefit public health and urged health professionals to use their respected and trusted role to build community understanding and action.

Ms McKenzie’s final question to the participants: “What can the Commission do to elevate the voice of health professionals on this issue?” is the subject of continuing discussion, and CAHA will share further feedback from members on this subsequently.

The meeting closed with the message that the climate communications evidence suggests that when climate change is talked about as a health issue, people are much more likely to respond as they see it in an individual context and as something that is personally relevant to them, rather than as a global environmental issue which is distant in time and space (“in the future, someone else, somewhere else”).

Coupled with the evidence that action on climate change can help reduce many existing disease burdens, and the esteem with which health professionals are held in the community, this makes for a powerful combination and a great opportunity for health professionals to influence this national and international conversation to help achieve better outcomes for health and wellbeing.